| 1. |
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| 2. |
- Brogårdh, Christina, et al.
(författare)
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The Benefit of a Flexible Ankle-Foot Orthosis on Balance and Walking Ability in Persons with Late Effects of Polio : A Mixed-Methods Study
- 2019
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Ingår i: Journal of Prosthetics and Orthotics. - 1040-8800. ; 31:2, s. 95-103
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT Introduction Many persons with late effects of polio (LEoP) have muscle weakness in the lower limbs, which affects their balance and walking ability. Although an ankle-foot orthosis (AFO) is commonly prescribed for these persons, there is limited knowledge if an AFO improves their balance and walking ability in terms of speed, distance, and perceived safety. The aims of this study were 1) to assess if a flexible AFO improves dynamic balance as well as indoor and outdoor walking in persons with mild to moderate LEoP and 2) to describe the participants' own perceptions of walking ability and safety, as well as advantages and disadvantages with an AFO. Materials and Methods A mixed-methods, repeated-measures, crossover design was used. Nineteen participants were assessed at two test occasions, with and without an AFO, with a 1-week interval. Dynamic balance was evaluated with the timed up and go (TUG) test and walking ability by the 10-m fast gait speed (FGS) tests, the 6-minute walk test (6MWT), and timed walking over a 340-m-long pathway outdoors. The Borg Rating of Perceived Exertion (RPE) scale was used to assess perceived exertion. The participants' perceptions of their walking ability and safety as well as advantages and disadvantages with an AFO were evaluated with questionnaires. Results The AFO significantly improved (P < 0.05) gait speed, outdoor walking, and reduced perceived exertion at one of the test occasions, but had no effect on dynamic balance (P > 0.6). A majority perceived significantly improved walking ability (P < 0.05) and increased walking safety (P < 0.01) with the AFO. Perceived advantages of the AFO were feelings of increased stability and walking distance and reduced risk of falling. Disadvantages were that it could be difficult to put on and uncomfortable to wear. Conclusions A flexible AFO marginally improves walking ability in persons with LEoP, as assessed quantitatively, but the subjective benefit of walking ability and safety suggests that a flexible AFO can be useful to improve daily functioning. In the future, the design of the AFOs needs to be more user-friendly. ©
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| 3. |
- Andersson, Nilla, et al.
(författare)
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Test-Retest Reliability of the Reintegration to Normal Living Index (RNL-I) to Assess Perceived Participation in Adults With Late Effects of Polio
- 2020
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Ingår i: PM&R. - : WILEY. - 1934-1482 .- 1934-1563. ; 12:2, s. 147-153
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many individuals with late effects of polio have difficulties participating in daily activities. The Reintegration to Normal Living Index (RNL-I) is a self-report questionnaire that evaluates perceived participation, but knowledge of the test-retest reliability and measurement errors in this population is lacking.Objective: To evaluate the test-retest reliability of the RNL-I in adults with late effects of polio.Design: A postal survey with a test-retest design.Setting: University hospital outpatient clinic.Participants: Fifty-one adults (20 women and 31 men; mean age 72 years) with late effects of polio.Main Outcome Measurements: The Reintegration to Normal Living Index (RNL-I).Methods: The participants responded to the RNL-I twice, 3 weeks apart. Data were analyzed with the following statistical methods: percentage agreement (PA), quadratic kappa coefficients, the intraclass correlation coefficient (ICC), mean difference, standard error of measurement (SEM/SEM%), and the smallest real difference (SRD/SRD%).Results: The PA (ie, the same scoring at both test occasions) was >70% for 10 of 11 items. The kappa coefficients showed good test-retest agreement (>0.61) for 7 items. The ICC was 0.88 and the mean difference was -0.74. The SEM (SEM%) was 7.4 (9.7%) and the SRD (SRD%) was 20.5 (27.0%).Conclusion: The RNL-I can be considered reliable for adults with mild to moderate late effects of polio. It can thereby be used to assess changes in perceived participation over time or after rehabilitation interventions, both for a group of individuals and a single individual.
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| 4. |
- Blom, Katarina Y., et al.
(författare)
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Early intervention with compression garments prevents progression in mild breast cancer-related arm lymphedema : a randomized controlled trial
- 2022
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Ingår i: Acta Oncologica. - 0284-186X. ; 61:7, s. 897-905
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early diagnosis and compression treatment are important to prevent progression in breast cancer-related arm lymphedema (BCRAL). However, some mild BCRAL can be reversible, and therefore, compression treatment may not be needed. The aim of this study was to investigate the proportion of women with mild BCRAL showing progression/no progression of lymphedema after treatment with or without compression garments, differences in changes of lymphedema relative volume (LRV), local tissue water and subjective symptoms during 6 months. Also, adherence to self-care was examined. Material and methods: Seventy-five women diagnosed with mild BCRAL were randomized to a compression group (CG) or noncompression group (NCG). Both groups received self-care instructions, and the CG were treated with a standard compression garment (ccl 1). Women in the NCG who progressed in LRV ≥2%, or exceeded 10% dropped out, and received appropriate treatment. The proportion showing progression/no progression of LRV, and changes in LRV was measured by Water Displacement Method. Changes in local tissue water were measured by Tissue Dielectric Constant (TDC), subjective symptoms by Visual Analogue Scale, and self-care by a questionnaire. Results: A smaller proportion of LRV progression was found in the CG compared to the NCG at 1, 2 and 6 months follow-up (p ≤ 0.013). At 6 months, 16% had progression of LRV in the CG, compared to 57% in the NCG, (p = 0.001). Thus, 43% in the NCG showed no progression and could manage without compression. Also, CG had a larger reduction in LRV, at all time-points (p ≤ 0.005), and in the highest TDC ratio, when same site followed, at 6 months (p = 0.025). Subjective symptoms did not differ between the groups, except at 1 month, where the CG experienced more reduced tension (p = 0.008). There were no differences in adherence to self-care. Conclusion: Early treatment with compression garment can prevent progression in mild BCRAL. Trial registration: ISRCT nr ISRCTN51918431.
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| 5. |
- Blom, Katarina Y., et al.
(författare)
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Impact on Health-Related quality of life after wearing compression garment or not for six months in women with mild breast cancer-related arm lymphedema. A cross-sectional study
- 2023
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Ingår i: Acta Oncologica. - 0284-186X. ; 62:5, s. 528-534
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Tidskriftsartikel (refereegranskat)abstract
- Background: Women with mild breast cancer-related arm lymphedema (BCRAL) mostly receive treatment with compression garments and instructions in self-care to prevent the progression of lymphedema. However, wearing a compression garment may be experienced as negative and may affect health-related quality of life (HRQOL) more than the lymphedema itself. The aim of this study was to investigate if there is a difference in lymphedema-specific HRQOL, between women with mild BCRAL wearing compression garments or not for 6 months. Material and methods: Participants with mild BCRAL (Lymphedema relative volume <10%) rated their HRQOL by the Lymphedema Quality of Life Inventory (LyQLI), 6 months after diagnosis and being randomized to compression group (CG) or non-compression group (NCG). Both groups received self-care instructions, and the CG was treated with a standard compression garment, compression class 1. Data from 51 women (30 in the CG and 21 in the NCG), were analyzed. Results: Both the CG and the NCG experienced a low negative impact on HRQOL in physical, psychosocial, and practical domains (score <1). However, the CG experienced a higher negative impact on median HRQOL in the practical domain compared to the NCG, 0.23/0.08 respectively, (p = 0.026). In the specific items, more participants in the CG reported a negative impact on HRQOL compared to the NCG in employment activities 23%/0%, (p = 0.032), embarrassment by lymphedema/compression garments 33%/5%, (p = 0.017), feeling discomfort/embarrassment while doing sports and hobbies 30%/5%, (p = 0.034) and having to answer questions about the lymphedema 27%/0% (p = 0.015). Conclusion: Overall, the lymphedema-specific HRQOL was high after 6 months in women with mild lymphedema, with only a minor difference between the groups. Some women may however perceive practical and emotional issues with the compression garment. These aspects should be considered in patient education and when planning/evaluating treatment. Trial registration: ISRCTN51918431.
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| 6. |
- Brogårdh, Christina, et al.
(författare)
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A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke.
- 2010
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 91:3, s. 460-464
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke. DESIGN: A 1-year follow-up after shortened CIMT (3h training/d for 2 wk) where the participants had been randomized to a mitt group or a nonmitt group. SETTING: A university hospital rehabilitation department. PARTICIPANTS: Poststroke patients (N=20, 15 men, 5 women; mean age 58.8 y; on average 14.8 mo poststroke) with mild to moderate impairments of hand function. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers. RESULTS: One year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time. CONCLUSIONS: Shortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed.
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| 7. |
- Brogårdh, Christina, 1968-
(författare)
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Constraint Induced Movement Therapy : influence of restraint and type of training on performance and on brain plasticity
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Partial paralysis of the hand is one of the main impairments after stroke. Constraint Induced Movement Therapy (CIT) is a new treatment technique that appears to improve upper extremity function after stroke. CIT consists of 6 hours of training/day for the affected arm (mainly with shaping exercises) and of restraint (mitt) of the non affected arm for two weeks. There are concerns about the practicality and resource issues in carrying out CIT according to the original model. In this thesis the benefit of modifications of CIT, of an assessment tool and of two common types of hand training have been evaluated. CIT (n=16) administered in groups for two weeks (paper I) seems to be a feasible alternative to improve upper limb motor function after chronic stroke. The arm/hand motor performance improved significantly on Motor Assessment Scale (MAS; p= 0.003) and on Sollerman hand function test (p= 0.037). The median self reported motor ability (MAL) also improved (p < 0.001). No additional effect was seen from wearing a mitt for an extended period of three months. The reliability of the Sollerman hand function test (paper II) was studied in patients with chronic stroke. Three examiners observed 24 patients at three experimental sessions. There was agreement (kappa ≥ 0.4) between the examiners for 15/20 subtests. Using total sum scores, the agreement within the examiners was higher than 0.96 (for Spearman’s rhos and ICCs) and agreement between the examiners was higher than 0.96 (Spearman’s rhos) and 0.92 (ICCs), respectively. In a cohort of 24 patients with subacute stroke (paper III) forced use therapy (FUT; mitt use and 3 hours of training/day for 2 weeks) improved arm/hand function, but not more than regular arm therapy given to the control group. Significant improvements in arm/hand motor performance were found in the FUT group (n=12) as well as in the control group (n=12) on the Sollerman hand function test (p= 0.001), on MAS (p< 0.05) and on MAL (p < 0.05). No significant differences were seen between the groups pre- or post training or at three months follow up, demonstrating that the mitt had limited importance. In a separate study on 30 healthy subjects (paper IV), employing transcranial magnetic brain stimulation (TMS), we found that shaping exercises but not general activity training increased dexterity (p<0.05; Purdue peg board test) of the trained non dominant hand. After shaping exercises the cortical motor map shifted forwardly into the premotor area but did not expand. After general activity training the cortical motor map expanded significantly (p=0.03) in the posterior (sensory) direction. Shift of location of active TMS positions rather than their numbers might therefore be a critical factor for the interpretation of cortical plasticity. In conclusion, the studies in this thesis have shown that less resource consuming modifications of CIT may be feasible to improve upper limb motor function after stroke. The type and amount of training for the more affected arm seems to be an important factor rather than the mitt use in itself. Shaping exercises, at least in healthy people, are effective in improving dexterity and the Sollerman hand function test reliable to evaluate arm/hand function after stroke.
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| 8. |
- Brogårdh, Christina, et al.
(författare)
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Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use
- 2006
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 20:3, s. 218-227
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Tidskriftsartikel (refereegranskat)abstract
- Objective: (1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome. Design: A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers. Setting: A university hospital rehabilitation department. Participants: Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb. Intervention: Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment. Outcome measures: Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log. Results: The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P < 0.001). However, no additional effect was seen from wearing a mitt for another three months. Conclusion: Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.
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| 9. |
- Brogårdh, Christina, et al.
(författare)
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Construct Validity of a New Rating Scale for Self-Reported Impairments in Persons With Late Effects of Polio.
- 2013
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Ingår i: PM & R : the journal of injury, function, and rehabilitation. - : Wiley. - 1934-1563 .- 1934-1482. ; 5:3, s. 176-181
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the construct validity of a new rating scale for self-reported impairments in persons with late effects of polio. DESIGN: Psychometric analysis of data on self-perceived impairments in persons with prior polio. PARTICIPANTS: Two hundred and seventy-three persons with prior polio (119 men and 154 women; mean age, 63.5 years). METHOD: Rasch analysis of a 13-item rating scale with 5 response categories, in which the participants rated how much they have been bothered by various post-polio-related impairments during the past 2 weeks. RESULTS: The initial analysis showed disordered categories, misfit with some of the items, multidimensionality, and local dependency. After adjustment of the categories, which resulted in a 4-category rating scale, fit to the model was achieved, but the scale still showed signs of multidimensionality. Analyses of local dependency revealed correlations among some of the items, which resulted in a 5 testlet solution, which gave fit to the model and unidimensionality. CONCLUSION: After adjustment of the categories and local dependency, this new rating scale, Self-Reported Impairments in Persons With Late Effects of Polio, can be considered as unidimensional. The good psychometric properties implies that the Self-Reported Impairments in Persons With Late Effects of Polio scale could be a useful rating scale that would increase our understanding of the impairments that persons with late effects of polio can experience. With further refinements, this scale may assist in the planning and evaluation of appropriate rehabilitation interventions.
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| 10. |
- Brogårdh, Christina, et al.
(författare)
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Determinants of falls and fear of falling in ambulatory persons with late effects of polio
- 2017
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Ingår i: PM&R. - : Elsevier. - 1934-1482 .- 1934-1563. ; 9:5, s. 455-463
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundFalls and fear of falling (FOF) are common in persons with late effects of polio but there is limited knowledge of associated factors.ObjectiveTo determine how knee muscle strength, dynamic balance and gait performance (adjusted for gender, age and BMI) are associated with falls and FOF in persons with late effects of polio.DesignA cross-sectional study.SettingA university hospital outpatient clinic.ParticipantsEighty-one ambulatory persons with verified late effects of polio (43 men; mean age 67 years).Main Outcome MeasurementsNumber of falls the past year, Falls Efficacy Scale –International (FES-I) to assess FOF, a Biodex dynamometer to measure knee muscle strength, the Timed Up and Go (TUG) test to assess dynamic balance and the Six Minute Walk test (6MWT) to assess gait performance. Univariate and multivariate logistic regression analyses were used for falls (categorical data) and linear regression analyses for FOF (continuous data) as dependent variables.ResultsFifty-nine % reported at least one fall during the past year and 79% experienced FOF. Reduced knee muscle strength in the more affected limb and gait performance were determinants of falls. An increase of 10 Nm in knee flexor and knee extensor strength reduced the OR between 0.70 and 0.83 (P=.01), and an increase of 100 meter in 6MWT reduced the OR to 0.41 (P=.001). All factors were determinants of FOF; reduced knee muscle strength in the more and less affected limbs explained 17% to 25% of the variance in FOF, dynamic balance 30% and gait performance 41%. Gender, age and BMI only marginally influenced the results.ConclusionsReduced gait performance, knee muscle strength and dynamic balance are to a varying degree determinants of falls and FOF in ambulatory persons with late effects of polio. Future studies need to evaluate if rehabilitation programs targeting these factors can reduce falls and FOF in this population.
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